Risk and Protective Factors for Firearm Assault Injuries Among Black Men: A Scoping Review of Research.

Black men are disproportionately affected by firearm assaults in the United States, and these disparities are rooted in structural and social inequities. The objective of this scoping review of research was to identify risk and protective factors for firearm assault injuries among Black men at all levels of the social-ecological framework. The search was conducted in 2021. The initial search generated 1,122 articles. Studies were eligible if they (a) included an analysis of modifiable risk or protective factors for firearm assaults among Black men; (b) reported an estimate of correlation, association, or effect between risk or protective factors and firearm assault injuries, firearm violence, and/or firearm homicides; and (c) were published peer-reviewed articles. In all, 19 articles were identified for review. Risk factors identified at each ecological level include the following: (1) Individual: firearm possession/weapon use and criminal legal system interaction; (2) Relationships: gang membership and exposure to other people who have experienced a firearm assault; (3) Community: indicators for socioeconomic status and racial residential segregation; and (4) Societal: historical racist policy. Individual-level substance use had mixed results. Few (26%) studies examined protective factors at any ecological level, but community-level factors like neighborhood tree cover were identified. Future research needs to examine risk and protective factors at the societal level and multiple ecological levels simultaneously leading to more effective multi-level interventions that will guide policy formation. A greater diversity of study designs, research methods, and theoretical frameworks is needed to better understand factors associated with firearm assault among Black men.

Impact of Sources of Strengths on Coping and Safety of Immigrant Survivors of Intimate Partner Violence.

Intimate partner violence (IPV) is a national and international public health and human rights concern. Immigrant women are disproportionately affected by IPV that includes homicides. This study explored the perspectives of survivors of IPV, who are immigrants to the United States, regarding their sources of strength that enhance their safety and promote coping in abusive relationships. Data for this qualitative study were collected from ethnically diverse immigrant women residing in Massachusetts, Arizona, Virginia, Washington, D.C., New York, Minnesota, and California, using purposive and snowball sampling techniques. Eighty-three in-depth interviews were conducted with adult immigrant survivors of IPV who self-identified as Asian (n = 30), Latina (n = 30), and African (n = 23). Data were analyzed using thematic analysis. Women identified both external (e.g., community support, support from social service agencies) and internal (e.g., optimism, faith, beliefs) sources of strength. The study highlights how these sources can adequately address needs of survivors and offers areas for improvement in services for survivors. The findings are informative for practitioners serving immigrant survivors of IPV in legal, social service, and physical and mental health settings.

We need to use words that we'd use in Brazil, right? A Community-Based Content Validation of a Translated Femicide Risk Assessment Instrument.

The Danger Assessment (DA) is a widely-used risk assessment instrument designed to help women understand their risk of femicide. Currently, no validated tool exists in Brazilian Portuguese. The purpose of this study was to conduct a cross-cultural adaptation of the DA for use in the Brazilian context as a precursor to validation and broader testing among women in Brazil. This study describes a community participatory approach for translation and cultural adaptation of the DA from European to Brazilian Portuguese that engages the target population in the process. Using a three-step process, a final version of the DA-Brazil instrument was developed.

The weWomen and ourCircle randomized controlled trial protocol: A web-based intervention for immigrant, refugee and indigenous women with intimate partner violence experiences.

Intimate partner violence (IPV), including homicides is a widespread and significant public health problem, disproportionately affecting immigrant, refugee and indigenous women in the United States (US). This paper describes the protocol of a randomized control trial testing the utility of administering culturally tailored versions of the danger assessment (DA, measure to assess risk of homicide, near lethality and potentially lethal injury by an intimate partner) along with culturally adapted versions of the safety planning (myPlan) intervention: a) weWomen (designed for immigrant and refugee women) and b) ourCircle (designed for indigenous women). Safety planning is tailored to women's priorities, culture and levels of danger. Many abused women from immigrant, refugee and indigenous groups never access services [WHY?] and research is needed to support interventions that are most effective and suited to the needs of abused women from these populations in the US. In this two-arm trial, 1250 women are being recruited and randomized to either the web-based weWomen or ourCircle intervention or a usual safety planning control website. Data on outcomes (i.e., safety, mental health and empowerment) are collected at baseline and at 3, 6, and 12 months post- baseline. It is anticipated that the findings will result in an evidence-based culturally tailored intervention for use by healthcare and domestic violence providers serving immigrant, refugee and indigenous survivors of IPV. The intervention may not only reduce risk for violence victimization, but also empower abused women and improve their mental health outcomes.

Women's strategies for coping with the impacts of domestic violence in Kyrgyzstan: A grounded theory study.

This paper provides an account of the adverse impacts of domestic violence on women in Kyrgyzstan and develops a grounded theory of coping among survivors of abuse. The results indicate that women adopt a range of strategies to prevent, avert, and minimize anticipated violence. Two key aspects of coping appeared in the narratives: 1) maintaining the status quo and 2) developing agency to resist the abuse. The results suggest that Government and nongovernmental organizations must take additional action to draw women to formal violence prevention services. Providing professional help at several levels (e.g., clinical, community, and societal) and promoting problem-focused strategies as part of therapeutic intervention are essential.

Validation and adaptation of the danger assessment-5: A brief intimate partner violence risk assessment.

AIMS: The aim of this study was to assess the predictive validity of the DA-5 with the addition of a strangulation item in evaluating the risk of an intimate partner violence (IPV) victim being nearly killed by an intimate partner. BACKGROUND: The DA-5 was developed as a short form of the Danger Assessment for use in healthcare settings, including emergency and urgent care settings. Analyzing data from a sample of IPV survivors who had called the police for domestic violence, the DA-5 was tested with and without an item on strangulation, a potentially fatal and medically damaging IPV tactic used commonly by dangerous abusers. DESIGN: Researchers interviewed a heterogeneous sample of 1,081 women recruited by police between 2009-2013 at the scene of a domestic violence call; 619 (57.3%) were contacted and re-interviewed after an average of 7 months. METHODS: The predictive validity of the DA-5 was assessed for the outcome of severe or near lethal IPV re-assault using sensitivity, specificity and ROC curve analysis techniques. RESULTS: The original DA-5 was found to be accurate (AUC = .68), equally accurate with the strangulation item from the original DA substituted (AUC = .68) and slightly more accurate (but not a statistically significant difference) if multiple strangulation is assessed. CONCLUSION: We recommend that the DA-5 with the strangulation item be used for a quick assessment of homicide or near homicide risk among IPV survivors. A protocol for immediate referral and examination for further injury from strangulation should be adopted for IPV survivors at high risk.

Robert Wood Johnson Foundation Nurse Faculty Scholars program leadership training.

BACKGROUND: The Robert Wood Johnson Foundation Nurse Faculty Scholars program was created to address the nursing shortage via development of the next generation of national leaders in academic nursing. PURPOSE: The leadership training combined development at the scholar's home institution with in-person didactic and interactive sessions with notable leaders in nursing and other disciplines. METHODS: A curriculum matrix, organized by six domains, was evaluated quantitatively and qualitatively. DISCUSSION: What set this program apart is that it immersed junior faculty in concerted leadership development with regard to all aspects of the faculty role so that teaching interactively, making use of the latest in information technology, giving testimony before a policy-making group, participating in strategic planning, and figuring out how to reduce the budget without jeopardizing quality were all envisioned as part of the faculty role. CONCLUSION: The domains covered by this program could easily be used as the framework to plan other leadership-development programs for the next generation of academic leaders.

A Mixed Methods Study of Contraceptive Effectiveness in a Relationship Context Among Young Adult, Primarily Low-Income African American Women.

BACKGROUND: Unintended pregnancy is an important public health issue. Rates of unintended pregnancy are disproportionately higher among women from racial and ethnic minority groups among whom rates of contraceptive use are lower. Women's multifaceted feelings about pregnancy and perceptions of their intimate relationships may influence contraceptive behavior. METHODS: We used mixed methods to examine women's perceptions of pregnancy, motherhood, and contraceptives within the context of their intimate relationships. A convenience sample of 130 primarily low-income African American women ages 18-29 completed a cross-sectional, computerized survey; 12 women provided in-depth qualitative interview data. Generalized linear mixed models were used to identify associations between study variables and contraceptive effectiveness. Interview data were analyzed using qualitative descriptive methods and integrated with quantitative data. RESULTS: Higher positive pregnancy attitude [odds ratio (OR) 0.78; 95 % confidence interval (CI) 0.63, 0.98], lower contraceptive attitude (OR 1.17; 95 % CI 1.01, 1.36), and more than one recent sexual partner (OR 0.03; 95 % CI <0.01, 0.60) were associated with less effective contraceptive use. Qualitative results included three themes: You get pregnant that's on you; Motherhood means everything; and Make sure you're stable. Women's qualitative reports primarily supported but occasionally diverged from quantitative findings, reflecting discrepancies from their stated ideals, personal goals, and behavior. CONCLUSION: The incongruities between women's ideals and their actual contraceptive behavior demonstrate the complexity of making reproductive decisions based on existing life circumstances and challenges. Health care providers should have broad understanding of women's pregnancy goals in order to recommend the most appropriate contraceptive methods and pre-conception counseling.

Domestic Violence Enhanced Perinatal Home Visits: The DOVE Randomized Clinical Trial.

BACKGROUND: Perinatal intimate partner violence (IPV) is common and has significant negative health outcomes for mothers and infants. This study evaluated the effectiveness of an IPV intervention in reducing violence among abused women in perinatal home visiting programs. MATERIALS AND METHODS: This assessor-blinded multisite randomized control trial of 239 women experiencing perinatal IPV was conducted from 2006 to 2012 in U.S. urban and rural settings. The Domestic Violence Enhanced Home Visitation Program (DOVE) intervention group (n = 124) received a structured abuse assessment and six home visitor-delivered empowerment sessions integrated into home visits. All participants were screened for IPV and referred appropriately. IPV was measured by the Conflicts Tactics Scale2 at baseline through 24 months postpartum. RESULTS: There was a significant decrease in IPV over time (F = 114.23; p < 0.001) from baseline to 1, 3, 6, 12, 18, and 24 months postpartum (all p < 0.001). Additional models examining change in IPV from baseline indicated a significant treatment effect (F = 6.45; p < 0.01). Women in the DOVE treatment group reported a larger mean decrease in IPV scores from baseline compared to women in the usual care group (mean decline 40.82 vs. 35.87). All models accounted for age and maternal depression as covariates. CONCLUSIONS: The DOVE intervention was effective in decreasing IPV and is brief, thereby facilitating its incorporation within well-woman and well-child care visits, as well as home visiting programs, while satisfying recommendations set forth in the Affordable Care Act for IPV screening and brief counseling.

Multiple Intimate Partner Violence Experiences: Knowledge, Access, Utilization and Barriers to Utilization of Resources by Women of the African Diaspora.

OBJECTIVE: This study examined knowledge, access, utilization, and barriers to use of resources among Black women exposed to multiple types of intimate partner violence in Baltimore, Maryland and the U.S. Virgin Islands (USVI). METHODS: We analyzed quantitative survey data collected by 163 women recruited from primary care, prenatal or family planning clinics in Baltimore and the USVI. In addition we analyzed qualitative data from in-depth interviews with 11 women. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis. RESULTS: A substantial proportion of Black women with multiple types of violence experiences lacked knowledge of, did not have access to, and did not use resources. Barriers to resource use were identified at the individual, relationship, and community levels. CONCLUSION: There is need for programs to develop awareness, promote access and utilization of resources, and eliminate barriers to resource use among abused Black women.

Gender and Race Variations in the Intersection of Religious Involvement, Early Trauma, and Adult Health.

PURPOSE: This study aimed to determine gender and race variations in regards to the influence of religious involvement (RI) as a moderator of the effects of early traumatic stress (ETS) on health-related quality of life among adult survivors of child abuse. DESIGN: A cross-sectional predictive design was used to study Seventh-day Adventist adults in North America (N = 10,283). METHODS: A secondary analysis of data collected via questionnaires was done using multiple regression. RESULTS: Data revealed that women had a significantly higher prevalence of any or all ETS subtypes, except for physical abuse prevalence, which was the same for both genders. Blacks reported a significantly higher prevalence of at least one ETS subtype than did Whites, except for neglect, where Whites had a higher prevalence. Exposure to at least one ETS subtype was associated with worse negative effect on mental health (B = -2.08, p < .0001 vs. B = -1.54, p < .0001) and physical health (B = -2.01, p < .0001 vs. B = -1.11, p < .0001) for women compared to men. Among those exposed to all ETS subtypes (n = 447), Whites had significant worse physical health, with White women having almost two times the negative effect on physical health (B = -4.50, p < .0001) than White men (B = -2.87, p < .05). As for RI moderation, based on tests of three-way interactions of race-RI-ETS, there were no associated differences. However, tests of three-way interactions of gender-RI-ETS showed a significant buffering effect. Among those with high levels of negative religious coping (RC), women exposed to ETS had significantly worse physical health (B = -1.28) than men. CONCLUSIONS: Results give evidence of gender and racial differences on the magnitude of the ETS-health effect, as well as gender differences in ETS-health buffering by RC. CLINICAL RELEVANCE: Findings suggest gender and racial differences must be considered when devising holistic nursing interventions for improving health outcomes of early trauma survivors.

Intimate Partner Violence and its Health Impact on Ethnic Minority Women [corrected].

In the United States, intimate partner violence (IPV) against women disproportionately affects ethnic minorities. Further, disparities related to socioeconomic and foreign-born status impact the adverse physical and mental health outcomes as a result of IPV, further exacerbating these health consequences. This article reviews 36 U.S. studies on the physical (e.g., multiple injuries, disordered eating patterns), mental (e.g., depression, post-traumatic stress disorder), and sexual and reproductive health conditions (e.g., HIV/STIs, unintended pregnancy) resulting from IPV victimization among ethnic minority (i.e., Black/African American, Hispanic/Latina, Native American/Alaska Native, Asian American) women, some of whom are immigrants. Most studies either did not have a sufficient sample size of ethnic minority women or did not use adequate statistical techniques to examine differences among different racial/ethnic groups. Few studies focused on Native American/Alaska Native and immigrant ethnic minority women and many of the intra-ethnic group studies have confounded race/ethnicity with income and other social determinants of health. Nonetheless, of the available data, there is evidence of health inequities associated with both minority ethnicity and IPV. To appropriately respond to the health needs of these groups of women, it is necessary to consider social, cultural, structural, and political barriers (e.g., medical mistrust, historical racism and trauma, perceived discrimination, immigration status) to patient-provider communication and help-seeking behaviors related to IPV, which can influence health outcomes. This comprehensive approach will mitigate the racial/ethnic and socioeconomic disparities related to IPV and associated health outcomes and behaviors.

Comparison of abuse experiences of rural and urban African American women during perinatal period.

A subsample of 12 African American women (6 urban and 6 rural) were selected from a larger longitudinal, randomized control trial, Domestic Violence Enhanced Home Visitation (DOVE-R01 900903 National Institute of Nursing Research [NINR]/National Institutes of Health [NIH]). All African American women were chosen to control for any racial- and/or race-related cultural differences that may exist among women across geographical areas. The experiences of abuse during the perinatal period are drawn from in-depth interviews conducted at five points in time during pregnancy and the post-partum period. The analysis describes three major themes that highlight the similarities and differences among rural and urban women. The main themes found were (1) types of abuse, (2) location of abuse, and (3) response to abuse. In addition, two sub-themes (a) defiance and compliance and (b) role of children were also identified. Implications for universal screening for women of reproductive age, safer gun laws, and the need for further research are discussed.

Intimate partner violence among African American and African Caribbean women: prevalence, risk factors, and the influence of cultural attitudes.

BACKGROUND: Women of African descent are disproportionately affected by intimate partner abuse; yet, limited data exist on whether the prevalence varies for women of African descent in the United States and those in the US territories. OBJECTIVE: In this multisite study, we estimated lifetime and 2-year prevalence of physical, sexual, and psychological intimate partner abuse (IPA) among 1,545 women of African descent in the United States and US Virgin Islands (USVI). We also examined how cultural tolerance of physical and/or sexual intimate partner violence (IPV) influences abuse. DESIGN: Between 2009 and 2011, we recruited African American and African Caribbean women aged 18-55 from health clinics in Baltimore, MD, and St. Thomas and St. Croix, USVI, into a comparative case-control study. Screened and enrolled women completed an audio computer-assisted self-interview. Screening-based prevalence of IPA and IPV were stratified by study site and associations between tolerance of IPV and abuse experiences were examined by multivariate logistic regression analysis. RESULTS: Most of the 1,545 screened women were young, of low-income, and in a current intimate relationship. Lifetime prevalence of IPA was 45% in St. Thomas, 38% in St. Croix, and 37% in Baltimore. Lifetime prevalence of IPV was 38% in St. Thomas, 28% in St. Croix, and 30% in Baltimore. Past 2-year prevalence of IPV was 32% in St. Thomas, 22% in St. Croix, and 26% in Baltimore. Risk and protective factors for IPV varied by site. Community and personal acceptance of IPV were independently associated with lifetime IPA in Baltimore and St. Thomas. CONCLUSIONS: Variance across sites for risk and protective factors emphasizes cultural considerations in sub-populations of women of African descent when addressing IPA and IPV in given settings. Individual-based interventions should be coupled with community/societal interventions to shape attitudes about use of violence in relationships and to promote healthy relationships.

The association between protective actions and homicide risk: findings from the Oklahoma Lethality Assessment Study.

This study focuses on the relationship between women's risk of homicide as measured by the Danger Assessment and 13 protective actions. Participants (N = 432) experienced an incident of police involved intimate partner violence (IPV) and subsequently completed a structured telephone interview. Most women in this sample experienced severe violence and were classified as being at high risk for homicide. Participants engaged in an average of 3.81 (SD = 2.73) protective actions. With the exception of the use of formal domestic violence services, women in the high-risk category were significantly more likely than women in the lower risk category to have used each of the protective actions examined. Implications for research and practice are discussed.

Factors influencing resource use by African American and African Caribbean women disclosing intimate partner violence.

Many victims of intimate partner violence (IPV) do not access services. Education and severity of physical violence have previously been shown to predict resource utilization, but whether these hold true specifically among women of African descent is unknown. This article furthers our understanding of the relationship between IPV and resource use, considering sociodemographics and aspects of IPV by presenting results from a study conducted with African American and African Caribbean women in Baltimore, Maryland, and the U.S. Virgin Islands. Of the 545 women included in this analysis, 95 (18%) reported emotional abuse only, 274 (50%) reported experiencing physical abuse only, and 176 (32%) had experienced both physical and sexual abuse by an intimate partner. Resource utilization was relatively low among these women, with only 57% seeking any help. Among those who did, 13% sought medical, 18% DV, 37% community, and 41% criminal justice resources. Generalized linear model results indicated that older age and severe risk for lethality from IPV and PTSD were predictive of certain types of resource use, while education, insurance status, and depression had no influence. Perceived availability of police and shelter resources varied by site. Results suggest that systems that facilitate resource redress for all abused women are essential, particularly attending to younger clients who are less likely to seek help, while building awareness that women accessing resources may be at severe risk for lethality from the violence and may also be experiencing mental health complications. In addition, greater efforts should be made on the community level to raise awareness among women of available resources.

Intimate partner violence and HIV risk factors among African-American and African-Caribbean women in clinic-based settings.

Despite progress against intimate partner violence (IPV) and HIV/AIDS in the past two decades, both epidemics remain major public health problems, particularly among women of color. The objective of this study was to assess the relationship between recent IPV and HIV risk factors (sexual and drug risk behaviors, sexually transmitted infections [STIs], condom use, and negotiation) among women of African descent. We conducted a comparative case-control study in women's health clinics in Baltimore, MD, USA and St. Thomas and St. Croix, US Virgin Islands (USVI). Women aged 18-55 years who experienced physical and/or sexual IPV in the past two years (Baltimore, n=107; USVI, n=235) were compared to women who never experienced any form of abuse (Baltimore, n=207; USVI, n=119). Logistic regression identified correlates of recent IPV by site. In both sites, having a partner with concurrent sex partners was independently associated with a history of recent IPV (Baltimore, AOR: 3.91, 95% CI: 1.79-8.55 and USVI, AOR: 2.25, 95% CI: 1.11-4.56). In Baltimore, factors independently associated with recent IPV were lifetime casual sex partners (AOR: 1.99, 95% CI: 1.11-3.57), exchange sex partners (AOR: 5.26, 95% CI: 1.92-14.42), infrequent condom use during vaginal sex (AOR: 0.24, 95% CI: 0.08-0.72), and infrequent condom use during anal sex (AOR: 0.29, 95% CI: 0.09-0.93). In contrast, in the USVI, having a concurrent sex partner (AOR: 3.33, 95% CI: 1.46-7.60), frequent condom use during vaginal sex (AOR: 1.97, 95% CI: 1.06-3.65), frequent condom use during anal sex (AOR: 6.29, 95% CI: 1.57-25.23), drug use (AOR: 3.16, 95% CI: 1.00-10.06), and a past-year STI (AOR: 2.68, 95% CI: 1.25-5.72) were associated with recent IPV history. The divergent results by site warrant further investigation into the potential influence of culture, norms, and intentions on the relationships examined. Nonetheless, study findings support a critical need to continue the development and implementation of culturally tailored screening for IPV within HIV prevention and treatment programs.

Collaborating with police departments: recruitment in the Oklahoma Lethality Assessment (OK-LA) study.

In a study to evaluate a collaborative police and social service intervention, researchers asked police officers to recruit intimate partner violence victims at the scene of domestic violence incidents. This article reviews the process of building successful partnerships with police departments as well as the strategies developed with collaborating police departments to create successful recruitment methods and enhance officer and department engagement with recruitment procedures. Over a period of 298 days, 800 victims were referred to the research study. Of these referrals, we were unable to contact 41.3%; of those contacted (n = 471), we conducted interviews with 67.73%.

Responding to the needs of culturally diverse women who experience intimate partner violence.

This paper presents the findings from a community based participatory research (CBPR) study that investigated the interface between culture and intimate partner violence (IPV) for women in selected cultural groups in Hawaii: Native Hawaiian, Filipino, Samoan, and Chuukese. The research question was, "What are the cultural perceptions, responses, and needs regarding IPV of selected individuals and groups served through a variety of programs that are affiliated with the three participating Community Health Centers (CHCs)?" This cross sectional, descriptive study collected both qualitative and quantitative data. Individual interviews were conducted with women who had experienced IPV. Focus groups were also conducted with other women from the same culture. Five common themes were identified across the four cultural groups: Living within a Collective; Cultural Protective Factors; Cultural Barriers to Helpseeking; Gender Specific Roles; and Belonging to a Place. The outcome from this study is increased knowledge that will be used to develop culturally appropriate interventions. Specific findings from each cultural group have been published. The purpose of this paper is to present common perceptions and responses to IPV from the four groups and suggest interventions based on the findings. Implications for practice are presented.

The danger assessment: validation of a lethality risk assessment instrument for intimate partner femicide.

The Danger Assessment (DA) is an instrument designed to assess the likelihood of lethality or near lethality occurring in a case of intimate partner violence. This article describes the development, psychometric validation, and suggestions for use of the DA. An 11-city study of intimate partner femicide used multivariate analysis to test the predictive validity of the risk factors on the DA from intimate partner femicide cases (N = 310) compared with 324 abused women in the same cities (controls). The results were used to revise the DA (four items added; one "double-barreled" item divided into two), and the calculated weights (adjusted odds ratios) used to develop a scoring algorithm with levels of risk. These levels of risk were then tested with an independent sample of attempted femicides (N = 194) with a final outcome of .90 of the cases included in the area under the receiver operating characteristic (ROC) curve.